According to Trisha E. O'Hehir, a hygienist and senior consulting editor for RDH -"When you tell people you are going to watch how thy brush their teeth , they often change what they do and how long they brush." Because informed consent is now required for all patients participating in dental studies, this makes gathering data extremely complicated.

Although it is no longer possible to gather this information without first telling the patient exactly what you plan to do. Ms. O'Hehir effectively argues that if we use what we have learned from previous studies that were conducted on unsuspecting brushers and combine it with our current clinical observation, we can use this knowledge to teach a more effective way to brush teeth.

Most of what we know about tooth brushing patterns and brushing times comes from studies published in the 70's by Drs. MacGregor and Rugg-Gunn. They conducted the study with patients who had agreed to participate in a dental study, but were not told that their brushing would be observed. They were simply told to go to the sink and brush their teeth before "beginning the study". What they did not know is that the doctors had installed a two way mirror complete with a video camera to record their actual tooth brushing.

Most of the subjects began by brushing the facial surface (the surface that you see when you smile) of the upper arch. Specifically, they tended to start on the side opposite their dominant hand. In other words, right-handed people brush first on the left side and left-handed people brush first on the right side.

The study suggested that the area one stats to brush may receive more brushing that other areas. In fact, the pattern observed most was that the brusher returned several times to first area brushed.

It was also found that many brushers neglected the lingual (tongue) surface entirely. Those who did brush the tongue side of their teeth spent only ten percent of their brushing time in that area, usually leaving it for last.

Overall brushing times were reported to be generally less that a minute, frequently less than 30 seconds. Reported tooth brushing times ranged form 20 to 85 seconds, with little or no time spent on the tongue side.

Ms. O'Hehir asks that with the above finding in mind consider this. The greatest accumulation of calculus and plaque is generally found on the tongue side of the lower teeth.

In addition, although it has been clearly demonstrated that patients who receive detailed hygiene instructions ( and practice the same) show a dramatic decrease in bacterial plaque. However, the lower tongue section, often the last brushed -if at all- showed the least amount of improvement.

The message is simple. If you want to remove plaque you need to brush where it is located. Since the most plaque in found on the tongue side of the lower teeth and you tend to brush longer on the surface you start-- Brush your teeth by starting on the tongue side of your lower teeth.